Abstract
ObjectiveTo follow up Japanese patients with type 1 diabetes for a maximum of 40 years to examine when they transitioned from pediatric care to adult care and to explore whether the attending physician, i.e., pediatrician or internist, was associated with prognosis.MethodsParticipants consisted of 1,299 patients who had been diagnosed as having type 1 diabetes at less than 15 years old between 1965 and 1979 identified through two nationwide surveys. Patients were classified as having received either pediatric care or adult care at the age of 15 and 30, and were compared for differences in mortality associated with the attending physician.ResultsThe attending physicians were confirmed for a total of 1,093 patients at the age of 15. Of these patients, 43.8% and 40.3% received pediatric care and adult care, respectively. Of the 569 patients receiving pediatric care, 74.2%, 56.6%, 53.4%, and 51.3% continued with pediatric care at 20, 30, 40, and 50 years old, respectively. The attending physicians (pediatrician or internist) at the age of 15 and 30 had no significant impact on their survival (P = 0. 892, 0.411, respectively).ConclusionsMore than half of the patients who had received pediatric care at the age of 15 continued to receive pediatric care even after the age of 30, suggesting that their transition was far from smooth, while the attending physician at the age of both 15 and 30 was not a prognostic factor for mortality. Thus, the timing for transition to adult care in these patients has no relationship with mortality in Japan.
Highlights
Despite recent advances in diabetes care, the mortality of childhood-onset type 1 diabetes is much higher than that seen in the general population [1,2,3]
Of the 569 patients receiving pediatric care, 74.2%, 56.6%, 53.4%, and 51.3% continued with pediatric care at 20, 30, 40, and 50 years old, respectively
A likely explanation for this excess mortality among patients with childhood-onset type 1 diabetes is that patients with type 1 diabetes in adolescence to emerging adulthood tend to show suboptimal glycemic control, which places them at risk of future diabetic complications [4,5,6,7,8]
Summary
Despite recent advances in diabetes care, the mortality of childhood-onset type 1 diabetes is much higher than that seen in the general population [1,2,3]. A likely explanation for this excess mortality among patients with childhood-onset type 1 diabetes is that patients with type 1 diabetes in adolescence to emerging adulthood tend to show suboptimal glycemic control, which places them at risk of future diabetic complications [4,5,6,7,8]. During this period, individuals in their teens to early twenties, including healthy people, experience significant physical, emotional, psychological, and social changes [5, 9]. Clinical practice for patients with type 1 diabetes entails enlisting the expertise of both pediatricians and internists as the patients move from childhood to adulthood, and their attending physician’s specialty, pediatrics or internal medicine, may affect their prognosis
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